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Results of coronary artery surgery in young adults
1Service de Chirurgie Cardiovasculaire, Hôpital de la Pitié, Paris, France.
Insights
Coronary artery bypass surgery in adults 40 or younger shows reduced risk and similar long-term outcomes compared to older patients. This study highlights the safety and efficacy of myocardial revascularisation in younger populations.
Area of Science:
- Cardiovascular Surgery
- Adult Cardiology
Background:
- Coronary artery disease affects younger adults, necessitating evaluation of surgical interventions.
- Risk factors in this cohort include smoking and hyperlipidaemia.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass surgery (myocardial revascularisation) in patients aged 40 years or younger.
- To assess the short-term and long-term prognosis following bypass surgery in this demographic.
Main Methods:
- Retrospective review of 221 patients (aged ≤40) undergoing myocardial revascularisation between 1979-1989.
- Analysis of operative mortality, perioperative complications, long-term survival, and symptom relief.
- Follow-up data collected for a mean of 7.4 years.
Main Results:
- Operative mortality was 2.7%, with 5.5% experiencing non-fatal perioperative myocardial infarction (MI).
- Overall survival reached 84% at 9 years, with 85% of patients remaining free of angina.
- Long-term prognosis appears comparable to the general population undergoing bypass surgery.
Conclusions:
- Coronary revascularisation is associated with reduced risk in younger adult patients.
- The long-term prognosis for bypass surgery in young adults is favorable and similar to older patient groups.
Abstract:
To study the results of bypass surgery in young adults, 221 patients undergoing myocardial revascularisation aged 40 or less (1979-1989) were reviewed. The study included 200 men and 21 women. Mean age was 36.2 years. Risk factors were essentially cigarette smoking (69.6%) and hyperlipidaemia (52%). One-hundred and eighteen patients (53.4%) had a history of previous myocardial infarction (MI) and 16 were operated on after an episode of preinfarction angina. One-hundred and twenty-nine patients had three-vessel disease, 59 had double-vessel disease and 33 single-vessel disease. Twenty-three had left main stem coronary artery lesions. Four-hundred and forty-six saphenous vein grafts and 79 internal mammary artery grafts were performed, an average of 2.3 grafts per patient. Operative mortality was 2.7% (6 patients). Deaths were caused in 4 cases by MI. Twelve patients (5.5%) had a non fatal perioperative MI. One-hundred and ninety-nine patients were followed up for a mean of 7.4 years (4838 patients-years). Seventeen late deaths occurred. Six were from cardiac causes. Overall survival was 84% at 9 years. Five patients underwent cardiac reoperation at a mean interval of 6.4 years after the primary procedure. Eighty-five% of patients were free of angina and 11.5% were in an improved condition. In conclusion, coronary revascularisation can be performed at a reduced risk in younger patients. Long-term prognosis seems similar to that of the overall group of patients undergoing bypass surgery.